OBJECTIVES: US dialysis centers typically dose ESA at every session (3x/wk), enabling frequent titrations. A once-monthly ESA is currently under FDA consideration. We recently demonstrated that more frequent Hb measurements and dose titrations are associated with higher ESA utilization. We developed an economic model to quantify the potential impact of switching from a 3x/wk ESA to one dosed monthly, due to fewer titrations and fewer Hb measurements, not considering other efficiencies (e.g., reduced administrations). METHODS: A cost-offset model estimated total ESA utilization and cost for monthly vs. 3x/wk dosing. Utilization inputs were derived from a retrospective study of prevalent (≥ 120 days), adult (> 18 years old) hemodialysis patients (n=78,730), dialyzing at a large dialysis organization between 01/01/09-12/31/10. Patients dosed 3x/wk experience 1.1 dose titrations and 2.9 Hb measurements on average per patient-month. Each additional monthly dose titration is associated with a 24.1% (95% CI: 21.5%-26.4%) increase in total ESA dose. Based on once-monthly ESA vs. 3x/wk ESA data  (Provenzano et al., ASN 2011), we projected  patients on a once-monthly ESA would experience 0.8 titrations and 1 Hb measurement per month, and projected savings-based reductions of mean titrations and tests. Price (derived from published sources), dose and clinical equivalence were assumed across ESAs. Model outcomes include incremental utilization and cost. RESULTS: The model predicts that switching patients to monthly ESA could result in a 7.95% (95% CI; 7.10%–8.73%) reduction in per-patient/month ESA utilization. This translates into savings of 5,322 (95% CI; 4,748–5,839 U) ESA units/month/patient and $52.37 (95% CI; $46.72–$57.46) per-patient/month. For an average facility (96 patients), we estimated ESA savings of 510,934 U/month and cost savings of $5,028/month. CONCLUSIONS: The model predicts that increasing the interval between ESA dose adjustments, based upon the FDA approval and administration of a once monthly ESA, could decrease ESA utilization.